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Virtual Therapy

Marian Bacon had been feeling sad and agitated for years. She tried a therapist but felt she wasn't getting anywhere. "I was still in my rut," says Bacon, 37, a social-services worker. She went to the clinic at a local college where she studies but became too embarrassed to continue after spying acquaintances in the waiting room.

So she turned instead to an unlikely source: the Internet. Bacon, who lives in Memphis, Tenn., found her current therapist, who lives in Washington state, while trolling the Web. For the past year, they've been chatting twice a week in a private chat room. At $40 for a 50-minute session and dial-up service at $29 a month, Bacon considers her e-therapy a bargain. For one thing, the therapist, who operates on Pacific time, had an appointment slot open at the end of the Tennessean's long day. Though she has yet to meet her therapist in person, Bacon says they have become so close she thinks of her as "a mother."

Convenience, anonymity and low prices—these are the familiar virtues of cyberspace, even when it comes to online mental-health services. Online therapy sessions often cost half the price of office visits. Though many psychologists insist that the Internet is no substitute for in-person sessions, there's evidence that e-therapy may be an effective treatment for some. Large studies have not been published yet, but preliminary research suggests that patients can do as well—or better—on the Web as on the couch, says University of Texas psychologist Aaron Rochlen, author of several surveys of the research.

One new service, ReflectiveHappiness.com, which was launched last year by University of Pennsylvania psychologist Martin Seligman, provides a six-part education in positive thinking for a monthly fee of $9. Each month, its 10,000 subscribers receive instructions for an exercise designed to help them appreciate their strengths and stop dwelling on their weaknesses and painful experiences. For help, users can click on a "virtual partner," an image of an actor delivering lines based on the experiences of real people.

Subscriber Donna Ryan, 43, is a believer. She fell into doldrums after being laid off from a job she loved. But her mood turned around last summer with an exercise on Seligman's site called "Three Blessings." As instructed, each night for a week she wrote down three things that had gone well that day and why. One rainy day, Donna, a mother of three who works as an administrative coordinator in Philadelphia, was struggling to get out of her car with her briefcase and umbrella when her 7-year-old son grabbed an umbrella and rushed out of their house to usher her in. That night, when writing down why her son was so helpful, Ryan gave herself credit for "raising a thoughtful, considerate child." It was the first positive thought she'd had about herself in months.

A pioneer in studying positive emotions, Seligman says he created the site after his studies persuaded him that engaging in regular positive-thinking exercises could lift depression—even major depression. Seligman compared patients who did the exercises with those taking an antidepressant while receiving typical psychotherapy at the University of Pennsylvania's mental-health clinic. The exercises were introduced in group-therapy sessions. "I was astonished that the exercisers did significantly better," Seligman says. Sixty-four percent of the positive-thinking patients were no longer depressed a year later, compared to just 8 percent of those who received "therapy as usual" and medication. Another study, reported in American Psychologist last summer, has shown that the exercises can be effective on their own, without the group meetings. Still, Seligman says there's more research to be done. "Don't throw your pills away," he cautions. He still believes the best approach is to do the exercises along with therapy.

The Internet can also be an effective option for recovering addicts who seek support from others in the same situation but are uncomfortable attending 12-step groups. For $1,200, eGetgoing.com gives alcoholics 12 weeks of group counseling. The sessions meet as a videoconference, but only the counselor is visible. Patients can communicate with the group over the computer, but they can only directly e-mail to the counselor. "It's engaging," says CEO Barry Karlin. "It's like watching a movie." The program has attracted more than 1,000 participants so far, and only 19 percent drop out of the program on average—much lower than the 60 percent dropout rate traditional in drug-addiction treatment, according to the Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health and Human Services. Initial surveys of past participants have found that nine months after completing the program, 80 percent report that they've stayed sober. A full-scale study will be completed this year.

For those who are shy or self-conscious, being invisible can help them to open up. "People are just uncomfortable with that face-to-face encounter," says Carone Sturm, publisher of Capalo Press, which sells an alcoholism-recovery program that is entirely online. "Some days we get 2,000 hits on the discussion forum. They love that they can go somewhere safe and anonymous and get help."

Online patients have the same range of difficulties as any patients, says Gerry Smith, an executive at the Toronto benefits firm WarrenShepell, which offers both kinds of therapy as part of the company's package of employee-assistance programs. Some opt for the online treatment because writing helps them clarify their thoughts. And they can hold onto the e-mailed responses from therapists and look at them when they need a boost. "They love that they can carry the e-mails around with them," says Smith.

There are different types of e-therapy, but patients should always check credentials, says John Grohol, publisher of PsychCentral.com. They should also take note of how thoroughly an e-therapist questions their state of mind: ethical e-therapists say that they won't take a suicidal patient since they can't easily arrange emergency help.

Though some psychologists believe in the power of online treatment, not everyone is a fan. The most frequent argument against e-therapy is that patients improve most in a strong relationship with a therapist experienced at reading faces and other nonverbal communication. "A person's hygiene, the way she dresses, these are all cues that can't be assessed online," says Lisa Cohen, a clinical psychologist at Beth Israel Medical Center in New York, adding that online therapy shouldn't replace an in-person evaluation and psychotherapy.

But Bacon is happy with her progress. She will complete her bachelor's degree next year and plans to attend graduate school. She credits her e-therapist with helping her recover from the memories of an earlier sexual assault in a foster home. She's even been able to cut back on her medication. "I'd recommend online therapy to anyone who isn't suicidal," she says. In fact, Bacon was so inspired that she's decided to pursue a career in mental health herself. "I want to help kids like me," she says—whether they're online or on a couch.